目的 探讨单侧与双侧椎弓根入路经皮椎体成形术(PVP)对骨质疏松性椎体压缩性骨折(OVCF)手术创伤程度及脊柱功能的影响。 方法 选取116例于我院2020年10月—2022年10月期间行PVP治疗的OVCF患者进行回顾性分析,据手术方式分为A组(单侧椎弓根入路)与B组(双侧椎弓根入路)各58例,记录两组围术期相关情况(手术时长/C臂机透视次数/骨水泥注入量/术后住院时长)。比较两组治疗前后Qswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分。比较两组术后并发症,包括骨水泥渗漏率和术后残留背痛发生率。结果 两组手术时长/C臂机透视次数/骨水泥注入量比较,且A组均低于B组,差异有统计学意义(P ＜ 0.05)；同组相比,治疗后伤椎Cobb角度数降低,椎体前缘高度度数增高(P ＜ 0.05),两组之间椎体Coob角及椎体前缘高度比较差异无统计学意义(P＞0.05)；同组相比,治疗后ODI值降低,JOA评分增高(P ＜ 0.05)；两组之间ODI值、JOA评分比较差异无统计学意义(P＞0.05)；两组术后并发症总发生率无明显差异,(P ＞0.05)。结论 单、双侧椎弓根入路微创手术治疗OVCF对患者脊柱功能的恢复及并发症发生无明显差异,且都非常理想,但在创伤程度上,单侧入路具有C臂机透视次数少、手术时长短、骨水泥注入量少等优势,能在保证手术效果的同时降低对患者的不利影响。

[Objective] To explore the effect of unilateral versus bilateral (percutaneous vertebroplasty) PVP on the degree of surgical trauma and spinal function in patients with osteoporotic vertebral compression fractures (OVCF). Methods One hundred and sixteen patients underwent PVP for OVCF in our hospital from October 2020 to October 2022 were retrospectively analyzed. Patients were classified into group A (unilateral PVP) and group B (bilateral PVP) according to different surgical approaches, each with 58 cases. Then the operation length, intraoperative blood loss, use of intraoperative fluoroscopy, bone cement injection volume and postoperative length of stay were recorded in both groups. The Cobb angle and the height of the anterior edge of the vertebral body were recorded at the baseline, 1 week, 3 months and 6 months after operation. The the Oswestry Disability Index (ODI) and Japan Orthopaedics Association (JOA) scores were compared between two groups. Results Compared with group B, group A had shorter operation time, less intraoperative blood loss, fewer use of intraoperative fluoroscopy, and smaller bone cement injection volume, with statistical difference (P<0.05). No statistical difference was found in postoperative length of stay between two groups (P>0.05). The Cobb angle and the height of the anterior edge of the vertebral body at the baseline, 1 week, 3 months and 6 months after operation yielded no statistical difference between two groups (P>0.05). Comparison within groups denoted that there was a decline in Cobb angle and an increase in the height of the anterior edge of the vertebral body after operation (P<0.05). ODI and JOA scores demonstrated no statistical difference between two groups at each time points (P>0.05). ODI showed a notable decrease and JOA had a remarkable increase in both groups after operation (P<0.05). Conclusion Good recovery of spinal function is observed under both unilateral and bilateral PVP for OVCF, but in terms of the degree of trauma, the unilateral approach has the advantages of shorter operative time, less intraoperative blood loss, fewer use of intraoperative fluoroscopy, and smaller bone cement injection volume, thus reducing the adverse effects while ensuring the surgical outcome.